Platt J F, Rubin J M, Ellis J H
Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0030.
Radiology. 1991 May;179(2):419-23. doi: 10.1148/radiology.179.2.2014284.
Ultrasonography (US) of the native kidneys is commonly requested for acute renal failure (ARF), although in most cases the examination results are negative. To detect changes in the Doppler waveform associated with ARF and determine whether Doppler US can provide significant diagnostic information not available with standard US, 91 patients with ARF were studied to determine a mean resistive index (RI) for each patient. Forty-six patients had acute tubular necrosis (ATN) with a mean RI +/- 1 standard deviation of .85 +/- .06, which was significantly higher than the mean RI of .67 +/- .09 in 30 patients with prerenal ARF (P less than .01). Fifteen patients had ARF due to non-ATN intrinsic renal disease (mean RI, .74 +/- .13). An elevated RI (greater than or equal to .75) occurred in 91% of patients with ATN versus only 20% of patients with prerenal azotemia. Patients with severe liver disease (hepatorenal syndrome) are a subset of those with prerenal ARF that accounted for most of the elevated RIs in this group. The study demonstrates that intrarenal Doppler US allows detection of changes associated with ARF far more often than standard US. More important, Doppler US may be helpful in distinguishing ATN from prerenal azotemia.
尽管在大多数情况下检查结果为阴性，但对于急性肾衰竭（ARF）患者，通常会要求对其自身肾脏进行超声检查（US）。为了检测与ARF相关的多普勒波形变化，并确定多普勒超声是否能提供标准超声无法提供的重要诊断信息，对91例ARF患者进行了研究，以确定每位患者的平均阻力指数（RI）。46例患者患有急性肾小管坏死（ATN），其平均RI±1标准差为0.85±0.06，显著高于30例肾前性ARF患者的平均RI 0.67±0.09（P<0.01）。15例患者因非ATN性肾内疾病导致ARF（平均RI，0.74±0.13）。ATN患者中91%出现RI升高（大于或等于0.75），而肾前性氮质血症患者中只有20%出现RI升高。严重肝病（肝肾综合征）患者是肾前性ARF患者的一个子集，该组中大多数RI升高的患者都属于这一类型。该研究表明，肾内多普勒超声比标准超声更常检测到与ARF相关的变化。更重要的是，多普勒超声可能有助于区分ATN和肾前性氮质血症。
